Paradigms of Psychiatry: Eclecticism and Its Discontents

Seyyed Nassir Ghaemi

Disclosures

Curr Opin Psychiatry. 2006;19(6):619-624. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: To assess paradigms of psychiatry, assessing their strengths and limitations.
Recent findings: The biopsychosocial model, and eclecticism in general, serves as the primary paradigm of mainstream contemporary psychiatry. In the past few decades, the biopsychosocial model served as a cease-fire between the biological and psychoanalytic extremism that characterized much of the 19th and 20th century history of psychiatry. Despite being broad and fostering an 'anything goes' mentality, it fails to provide much guidance as a model. In recent years, the biological school has gained prominence and now is under attack from many quarters. Critics tend toward dogmatism themselves, usually of postmodernist or libertarian varieties. Three alternate approaches include pragmatism, integrationism, and pluralism. Pluralism, as technically defined here based on the work of Karl Jaspers, rejects or accepts different methods but holds that some methods are better than others for specific circumstances or conditions.
Summary: The compromise paradigm of biopsychosocial eclecticism has failed to sufficiently guide contemporary psychiatry. The concurrent revival of the biological model has led to postmodernist counter-reactions which, though valid in many specifics, promise to replace one ideological dogma with another. New paradigms are needed.

Introduction

Kuhn[1] coined the term paradigm to denote the conceptual structure within which scientific work occurs. All scientific observation is conditioned by preexisting theories or assumptions, according to Kuhn. A paradigm is the sum of those underlying assumptions. Major changes in science happen when the underlying assumptions of a paradigm are thrown into doubt.

Theories and models can either be specific, in which case they are often hypotheses that function within a paradigm, or more general, in which case they can approximate what Kuhn had in mind.

Kuhn felt that the role of paradigms was to provide a coherent overall structure in which specific observations, hypotheses, and theories could exist. In the case of psychiatry, we would expect paradigms or general models to provide information about the following nonexhaustive list: the nature of mental illness, the structure of the mind, the relation of mind to brain, the relation of mental illness to physical illness, the relation of mental illness to society, the nature of mental states and psychological concepts, definitions of specific mental pathologies, the cause of those pathologies, the course of those pathologies, treatments for those pathologies, an ethical framework for practitioners who treat mental illness, guidance on how to cope with mental illnesses for those who have them, guidance regarding how to provide resources to research mental illness, guidance regarding how to conduct research on mental illness, and information to guide politicians and the public regarding creating laws related to mental illness.

Obviously no paradigm can meet all these needs, but an assessment of them should be taken into account.

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